[Pressure] Pressure Adjustments

[unrested]

Okay, I'm on day 34 of treatment and I have struggled with stomach pain, bloating, gas and back pain. The last four days have however been the best I have felt in as long as I can remember... even with this pain. Being on a bi-pap with 14/6 pressure maxing out and my AHI now hovering at 17.01 over the past seven days and 23 over the past 30 I requested the doc lower my pressure to see if I can reduce the stomach pain. Basically I wake with stomach pain around 4:30 - 5:00 a.m. and by 5:30 it is so bad I have to get out of bed. Once I'm up for 30 - 45 minutes the pain becomes tolerable.

Today the doc agreed to lower the pressure but stated my AHI's will go back up. So my dilemma, do I lower it or should I tough it out a bit longer? 99% of my AHI's are showing as Clear Airway's.

Any thoughts from those of you who have experimented with pressure adjustments in the past?

Thanks from an unrested soul who is finally getting some sleep.

[genes]

I assume your pressure setting came from your sleep test. Before I changed any settings I would make sure that I wasn't breathing through my mouth or swallowing air (could cause bloating) while using your machine. If you are your machine will not be effective and changes to the pressure wont solve problems caused by mouth breathing. It only makes it harder to figure out what your pressure should be.
GeneS

[jdireton]

You're doing great! Really, for as new as you are to therapy you are doing well. The aerophagia will get better. Other side effects, sinus issues, back pain, waking at 3:00 am, etc. will get better.

To be honest, decreasing your pressure is probably going in the wrong direction. I won't ever disagree with your doctor, but I think you might just want to stay with it for a while. Please note that BiPaP therapy is at the edge of the xPAP range. ASV (Adaptive Synchronus Ventilation) s the extreme edge of the treatment range.

I am not a doctor, but there is a point where discomfort conflicts with therapy. You may want to decrease pressures to deal with discomfort, but remember that the long term goal is effective therapy. Keep an open mind, what may be intolerable today you will adjust to.

Sorry, not really great advise, but keep with it, keep with the pressure you need for effective therapy, and try to adapt. I can only say that I think the long term benefit will be worth it!

[PaulaO2]

Or, decrease it until the gas clears then slowly increase it again.

[zonk]

Today the doc agreed to lower the pressure but stated my AHI's will go back up. So my dilemma, do I lower it or should I tough it out a bit longer? 99% of my AHI's are showing as Clear Airway's.

Any thoughts from those of you who have experimented with pressure adjustments in the past?

Thanks from an unrested soul who is finally getting some sleep.

I've played with my pressure up and down but don,t use VPAP or have central apnea

if doc agree ... don,t see any problem lowering inhale pressure as centrals are not treated with pressure increase
its worth a try if going to make the therapy more comfortable ... any therapy is better than no therapy .. there is always going to be trade-off
go by how you feel, what the data tells you and works with the doc if adjustment is needed

[unrested]

I assume your pressure setting came from your sleep test. Before I changed any settings I would make sure that I wasn't breathing through my mouth or swallowing air (could cause bloating) while using your machine. If you are your machine will not be effective and changes to the pressure wont solve problems caused by mouth breathing. It only makes it harder to figure out what your pressure should be.
GeneS

Hi GeneS,

Yup, the settings came out of the sleep test. I do know I'm not breathing out of my mouth as anytime I open it I sound like a beached whale and my wife wacks me, not to mention it wakes me relatively quickly.

[unrested]

You're doing great! Really, for as new as you are to therapy you are doing well. The aerophagia will get better. Other side effects, sinus issues, back pain, waking at 3:00 am, etc. will get better.

To be honest, decreasing your pressure is probably going in the wrong direction. I won't ever disagree with your doctor, but I think you might just want to stay with it for a while. Please note that BiPaP therapy is at the edge of the xPAP range. ASV (Adaptive Synchronus Ventilation) s the extreme edge of the treatment range.

I am not a doctor, but there is a point where discomfort conflicts with therapy. You may want to decrease pressures to deal with discomfort, but remember that the long term goal is effective therapy. Keep an open mind, what may be intolerable today you will adjust to.

Sorry, not really great advise, but keep with it, keep with the pressure you need for effective therapy, and try to adapt. I can only say that I think the long term benefit will be worth it!

Thanks for the thoughts and ideas jdireton!

I had asked for the pressure drop a week ago when everything seemed to be going backwards. I was in pain, not sleeping well, air leaks, waking, tired during the day and so on. Then I figured out a way to sleep on my side again and the past 4 days have been restful... but the pain still persists... but... now I doubted myself for requesting a lower pressure as I don't want to change the rested feeling I have had the last 4 days even with the stomach and back pain.

The one thing I do know, I'll keep on using the machine as it does work. I'm thinking it's like adjusting a carburetor to get the best results. :grin: Now, what pressures I'll be at, how to handle the pain/discomfort and how I can better control air leaks are my challenges.

[unrested]

Today the doc agreed to lower the pressure but stated my AHI's will go back up. So my dilemma, do I lower it or should I tough it out a bit longer? 99% of my AHI's are showing as Clear Airway's.

Any thoughts from those of you who have experimented with pressure adjustments in the past?

Thanks from an unrested soul who is finally getting some sleep.

I've played with my pressure up and down but don,t use VPAP or have central apnea

if doc agree ... don,t see any problem lowering inhale pressure as centrals are not treated with pressure increase
its worth a try if going to make the therapy more comfortable ... any therapy is better than no therapy .. there is always going to be trade-off
go by how you feel, what the data tells you and works with the doc if adjustment is needed

Thanks Zonk

I need to read up more on the centrals as they seem to be my primary downfall. I was never given a copy of my sleep study report, only an AHI number and a diagnosis of severe sleep apnea, but I do have copies of my reports since starting therapy.

This board has been great and everyone so helpful in providing much needed feedback as I try to educate myself.

Thanks again

[genes]

I assume your pressure setting came from your sleep test. Before I changed any settings I would make sure that I wasn't breathing through my mouth or swallowing air (could cause bloating) while using your machine. If you are your machine will not be effective and changes to the pressure wont solve problems caused by mouth breathing. It only makes it harder to figure out what your pressure should be.
GeneS

Hi GeneS,

Yup, the settings came out of the sleep test. I do know I'm not breathing out of my mouth as anytime I open it I sound like a beached whale and my wife wacks me, not to mention it wakes me relatively quickly.

I am not sure you are controlling your mouth breathing. The people on this forum seem to control mouth breathing with a good chin strap and also a full face mask if the chin strap alone does not do it. I would think that if you had a good chin strap you would not be able to open your mouth that easily? You could also leak from your mouth or breath in when it is not fully open without waking your wife. I will not bug you anymore about mouth breathing but I think with a nasal mask it is important.
GeneS

[Allen]

I agree with genes about the mouth breathing and need of a chin strap. When I did my overnight sleep study using a nasal mask, the same model as I now own, I began mouth breathing and the first I knew of this was when the nurse woke me to put a chin strap on me.